Urinary Tract Infection Prevention

urinary-tract-infectionTravel advice including Prevention of Urinary tract infection:

Tormented by Cystitis when you go on holidays?
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Our Cystitis Questionnaire


What is Urinary Tract infection (UTI)?

This is infection of the excretory pathways (plumbing) leading from the kidney to the urethral opening.

What types of ITI are there?

We see three main types:

  • Lower Urinary Tract Infection (UTI) ie Cystitis
  • Upper UTI (Pyelonephritis)
  • Urethritis (infection of the urethra carrying urine from the bladder to the skin surface

Prostatitis and Pelvic Inflammatory Disease are extremely important but beyond the scope of this article

Cystitis

This is extremely common in women and arises from colonisation of the vulva by bowel germs owing to the mechanics of the female pelvis.

The female urethra is short (1 – 2 cm) so bacteria can easily get into the urethra. This is even more likely during sex, when the urethra is repeatedly compressed and somewhat shortened.
The germs are mainly the woman’s own bowel flora and their antibiotic sensitivities largely reflect recent antibiotic consumption.

The situation of chronic ITI in elderly men is beyond the scope of this article.

Pyelonephritis

Pyelonephritis (kidney infection) can be an ascending infection from cystitis or (especially in children) from blood borne infection.
The patient is usually quite ill with fever vomiting and intense one sided flank pain.

Urethritis

Urethritis is mostly a Sexually Transmissible Disease.
The main infective organisms are:

  • Ureaplasma (common but mostly not serious) (up to 70% sexually active people)
  • Chlamydia (about 5 – 12% but 25% get complications if not promptly treated
  • Mycoplasma (about 2% with same implications as for Chlamydia). 70% of patents are unaware they have these germs
  • Gonorrhoea (about 0.5%) By contrast, most men and half the women are fully aware they are infected owing to discharge and discomfort.

With particular focus on overseas travel, the main two conditions are Cystitis and Urethritis. Urethritis is unlikely unless one is having sex with strangers. This of course is the whole point of an overseas holiday for some, (but definitely not for all) travellers. As 70% of patients with an acute STD have few or no symptoms, this invites the question: How often should I have an STD test? See Section XXXXXXX

How often should I have an STD test?

The simple answer is: every time you have unprotected sex with a new partner.
Those people who find this advice alarming have (to my mind at least), not thought things through.

The take home message is: if you have unprotected sex with strangers on holiday: (ANY mucous membrane (moist surface) contact at all!!), then attend your local GUM clinic once you get home, where you will receive excellent, confidential and professional care.

As regards Cystitis: clearly prevention is better than treatment.

What can I do to avoid Cystitis on holiday?

The same advice your GP and your Mum gave: have a shower before bedtime, drink lots of water before sex, empty the bladder before (for reasons of comfort) and as soon as possible after sex, to empty the bladder again.
This is to wash out any germs that may have gained entry to the bladder during sex.
It is also important to avoid dehydration, as a more diluted germ laden urine is less likely to infect you.

What about Cranberry?

Cranberry has in fact been to show reasonable preventative action in UTI. However Cranberries are quite sour and not palatable to most people. If you can bite a lime or a lemon, you can take Cranberry. To make Cranberry palatable to most consumers, then either sugar is added or artificial sweeteners. The sugar can increase the chance of infection, especially in large amounts and the sweetener, depending on the type, may make the bladder more irritable.

How does Cranberry help?

The main germ seen in UTI is the patient’s own E Coli, the main bowel germ. As E Coli has flagellae (like little legs), it can swim upstream into the bladder even without the mechanical assistance from sex. Cranberry makes the bladder wall more effectively “slippery” to the E Coli and they are washed out before they get a hold. It is a little like greasing a pole before someone tries to climb it.

Is there something more “chemical” to do this?

Yes, the sugar d-Mannose taken in doses of 1- 2 heaped teaspoons in water prior to intercourse, has the same action but acts more reliably in practice. Internet search will locate the cheapest sources of this. Only buy the powder, or it is too expensive.

What else can I take?

Doctors for decades have recommended low dose anti-microbials (antibiotics) taken just prior to or just after sex to prevent UTI.

We try to use antibiotics that we are unlikely to use otherwise to avoid germ drug resistance.

What are the main options?

Nitrofurantoin 200 mg and the Quinolone drugs eg Ciprofloxacin (Cipro) 500mg and Cefalexin 500 mg are the main ones we use in General Practice for this purpose.

What specific problems do we see with these drugs infrequently?

  • Nitrofurantoin: lung disease can occur with prolonged use.
    This is extremely unlikely when used for the prevention of UTI.
  • Ciprofloxacin: Achilles tendon rupture has been seen in athletes taking Cipro. So, if your travel will involve sprinting or especially ascending steep paths while carrying a heavy back pack, then Cipro may not be your best choice.
  • Ceflexin; this is a well tolerated general antibiotic, however the fact it is much used for respiratory tract infections increases the likelihood of resistance and reduces its chance of being the ideal drug.

NB All antibiotics can cause Monilia (vulvovaginitis/ thrush/candida).
This generally responds well to local antifungal/ anti-yeast medications and single dose Fluconazole 150 mg both obtainable without prescription.

Price List

Medication Strength per dose Pack size Price £
Trimethoprim 200mg 6 15
Nitrofurantoin 100mg 6 19